過敏性鼻炎的診斷和治療

1、Nasal mucosal hyperreactive rhinopathyAllergic Rhinitis (AR)Perennial~(PAR), Seasonal~(SAR) （Pollinosis）Morbidity: 10%~20%Inhalant allergens——dust mite, house dust, pollen, fungi, animal danders, cockroach；Food all

2、ergens——milk, eggs, fish and shrimp, meat, vegetables, fruits.,Mite,Mold,Pollen,Cat,Antigens for allergic rhinitis,變應(yīng)性鼻炎的病因?qū)W,內(nèi)在因素──遺傳因素：有家族史者較無家族史者發(fā)病危險高２～６倍母系第１１對染色體長臂ｑ段 外在因素（環(huán)境因素）：基因表達受非遺傳因素影響。７０００對孿生兒，同時有AR 癥狀者為２１％

3、 易感個體在一定環(huán)境條件作用下才發(fā)病,變應(yīng)原與致敏靶細胞表面IgE結(jié)合,致敏靶細胞脫粒、釋放、合成生物活性介質(zhì),肥大細胞,儲備的介質(zhì),新合成的介質(zhì),組胺,緩激肽,白三烯,血小板活化因子,前列腺素D2,毛細血管擴張、通透性增加，腺體分泌增多,嗜酸/堿性粒細胞,哮喘,鼻炎,發(fā)病機制,,,,,,,,,,,,,Pathology：Type ? allergy Allergic inflammation: Predominant T cel

4、ls & eosinophilic cells infiltrate.,Symptoms & Signs：Nasal irritation and ichingrecurrent attacks of paroxysmal sneezing copious watery rhinorrheanasal obstruction,,,,,鼻后滴漏,Diagnosis：1、History（allergen expos

5、ure, hypersensitivity, family history）2、Examination3、Skin test: skin prick test 4、IgE antibody，Serum total IgE 、special IgE5、Nasal provocation or nasal chanllenge tests,Differential Diagnosis：1、Vastomotor rhinitis

6、2、Nonallergic rhinitis with eosinophilia syndrome, NARES3、Hyperreflectory rhinitis4、Acute rhinitis,Complications：1、Allergic sinusitis2、Asthma3、Secretory otitis media 4、Allergic pharyngolaryngitisTreatment：1、Avoid

7、ance,2、Drugs1）Antihistamines2）Corticosteroids3）Sodium cromoglycate(SCG) Cromolyn sodium4）Anticholinergic agents5）Vasoconstrictor sympasthomimetics3、Hyposensitization4、Others：Traditional Chinese medicine, laser, o

8、peration,Nasal Polyp & Nasal PolyposisEtiology：mutilfactors 1.allergic；2.chronic inflammation Pathology：highly swelled connective tissue. Predominant eosinophilic cells infiltrate. Lymphatic cells, neutrophils, bas

9、ophils, mast cells.,,Polyp in maxillary sinus（L），polyp in middle meatus（R）,Symptoms & Sign：persistent nasal obstruction，close nasal sound，hyposmia, rhinorrhea, snore, “frog nose”,Antrochoanal polyp,Antrochoanal poly

10、p,Diagnosis： Anterior rhinoscopy：translucent, soft, smooth masses. Endoscopy, X-ray and CT scanner.Differential Diagnosis： Papilloma inverted，angiofibroma of nasopharynx，malignant tumor of nasal cavity，meningoencephal

11、oceleTreatment：1、conservative treatment——corticosteroids 2、surgical treatment,Polyps（above），papilloma（below）,papilloma（L），MT of nasal cavity （R）,SinusitisAcute suppurative sinusitisFeatures of sinus anatomy：1、small o

12、stia of the sinuses； 2、continuative mucosa between nasal cavity and sinuses；3、contiguous of the ostia；4、location of the astia and features of the sinuses.,Frontal Sinus,Ethmoid SinusMaxillary Sinus,E

13、tiology：1、General factors: Poor general health (influenza, measles, whooping cough…)2、Local factors：Sinus diseases；Infective focus of eripheral organs，Direct infection；Nasal tampon (packing)；Rapid change of atmosp

14、heric pressure,ABS主要病原體：肺炎鏈球菌和嗜血流感桿菌,SAHP. Otolaryngol Head Neck Surg. 2004;130:1-45.,20-43%,22-35%,Anaerobes 0-9%,Staphylococcus aureus 0-8%,Other bacteria 4%,Moraxella catarrhalis,Other streptococci 3-9%,,,,2-1

15、0%,S. pneumoniae,,,,成人Acute bacterial rhinosinusitis (ABS)病因,H. influenzae,,兒童Acute bacterial rhinosinusitis (ABS)病因,ABS主要病原體：肺炎鏈球菌、嗜血流感桿菌和卡他莫拉菌,Otolaryngol Head Neck Surg. 2004;130:1-45.,Symptoms & Signs：General sy

16、mptoms：Malaise, fever.Local symptoms:1）Nasal obstruction sustained, with hyposmia2） Suppurative rhinorrhea, streaky with blood, foul smell(odontogentic~)3）headach or local ache,Antral pain——from inner canthus downw

17、ards across the cheek, upper alveolus on the affected side.Ethmoidal pain——over bridge of the nose & inner canthus behind the eye. Frontal pain——forehead, periodicity, persist for an hour or tow after getting up in

18、 the morning, and clear during the afternoon.Sphenoidal pain——occipital or vertical headache.,Diagnosis：History，Signs, Anterior rhinoscopy, Nasal endoscopy, Radiological examination, Puncture and irrigation of max

19、illary sinus,Treatment：Eradicate causes，keep drainage；control infection and prevent complications1、General treatment：take rest，antibiotics，antihistamine (if necessary )2、Local treatment3、Body drainage4、Physical thera

20、py5、 Puncture and irrigation of maxillary sinus,Maxillary sinus puncture and irragation,Chronic suppurative sinusitisEtiology：Acute——?ChronicSymptoms & Signs：General~:Local~：

21、 rhinorrhea, nasal obstruction, headache, hy

22、posmia, vision disorder,Diagnosis：1、History；2、Examination：anterior rhinoscopy, nasal endoscopy3、Radiological examination：CT or MRI4、Puncture and irrigation of si

23、nus,Normal image of nasal endoscopy,Maxillary sinusitis——pus in the middle meatus,Maxillary sinusitis(R),,Sphenoid sinusitis——pus in the sphenoethmoidal recess,Sphenoid sinusitis,Pansinusitis,Pansinusitis,Treatment：1、In

24、tranasal medications：Corticosteroid， Vasoconstrictor sympasthomimetics 2、Puncture and irrigation of maxillary sinus 3、Displacement method——frontal sinusitis, ethmoidal sinusitis, sphenoidal sinusitis, pansinusitis 4、S

25、urgery——traditional sinus surgeryFunctional Endoscopic Sinus Surgery(FESS) Ostiometal complex OMC,,Functional Endoscopic Sinus Surgery(FESS),復(fù)習(xí)與思考：1、鼻腔外側(cè)壁的解剖結(jié)構(gòu)及其與臨床的關(guān)系如何？2、變應(yīng)性鼻炎有何臨床表現(xiàn)，應(yīng)與哪些疾病相鑒別？3、如何診斷鼻竇炎？4、鼻息肉應(yīng)與哪